nar-a-TRIP-tan

Therapeutic Classification: vascular headache suppressants

Pharmacologic Classification: five ht1 agonists

• Acute treatment of migraine headache.

• Acts as an agonist at specific 5-HT₁ receptor sites in intracranial blood vessels and sensory trigeminal nerves.

• Cranial vessel vasoconstriction with resultant decrease in migraine headache.

Absorption: Well absorbed (70%) following oral administration.

Distribution: Extensively distributed to tissues.

Metabolism/Excretion: Primarily metabolized in the liver. 60% excreted unchanged in urine; 30% metabolized by the liver.

Half-life: 6 hr (↑ in renal impairment).

(↓ migraine pain)

†3–4 hr during migraine attack.

Contraindicated in:

• Hypersensitivity
• Ischemic heart disease or Prinzmetal's angina
• Uncontrolled hypertension
• Wolff-Parkinson-White syndrome or other arrhythmias involving conduction pathways
• Hemiplegic or basilar migraine
• Stroke or transient ischemic attack
• Peripheral vascular disease
• Ischemic bowel disease
• Severe renal impairment (CCr <15 mL/min)
• Severe hepatic impairment.

Use Cautiously in:

• Mild to moderate renal impairment (dose should not exceed 2.5 mg/24 hr; initial dose should be ↓)
• Mild to moderate hepatic impairment (dose should not exceed 2.5 mg/24 hr; initial dose should be ↓)
• OB: Safety not established in pregnancy
• Lactation: Safety not established in breastfeeding
• Pedi: Safety and effectiveness not established in children
• Geri: Age-related ↓ in renal function and ↑ likelihood of CAD greatly ↑ risk of fatal adverse events in older adults.

Exercise Extreme Caution in:

• Cardiovascular risk factors (hypertension, hypercholesterolemia, cigarette smoking, obesity, diabetes, strong family history, menopausal women, or men >40 yr); use only if cardiovascular status has been evaluated and determined to be safe and 1st dose is administered under supervision.

CV: CORONARY ARTERY VASOSPASM, MI, myocardial ischemia, VENTRICULAR FIBRILLATION, VENTRICULAR TACHYCARDIA.

GI: nausea.

Neuro: dizziness, drowsiness, fatigue, paresthesia.
Misc: pain/pressure sensation in throat/neck.

Drug-Drug:

• ↑risk of serotonin syndrome when used with SSRIs or SNRIs.
• Cigarette smoking↑ the metabolism and ↓ levels of naratriptan.
• Levels and risk of toxicity are ↑ by hormonal contraceptives.
• Avoid concurrent use (within 24 hr of each other) with ergot-containing drugs (dihydroergotamine); may result in prolonged vasospastic reactions.
• Avoid concurrent (within 2 wk) use with MAO inhibitors; produces ↑ systemic exposure and risk of adverse reactions to naratriptan.

Drug-Natural Products:

• ↑risk of serotonergic side effects including serotonin syndrome with St. John’s wort and SAMe.

• PO (Adults): 1 or 2.5 mg; dose may be repeated in 4 hr if response is inadequate (not to exceed 5 mg/24 hr or treatment of more than 4 headaches/mo).

(Generic available)

• Tablets: 1 mg; 2.5 mg;

• Assess pain location, character, intensity, and duration and associated symptoms (photophobia, phonophobia, nausea, vomiting) during migraine attack.
• Monitor for serotonin syndrome in patients taking SSRIs or SNRIs concurrently with naratriptan.

• PO: Tablets may be administered at any time after the headache starts.

• Inform patient that naratriptan should be used only during a migraine attack. It is meant to be used for relief of migraine attacks but not to prevent or reduce the number of attacks.
  • Instruct patient to administer naratriptan as soon as symptoms of a migraine attack appear, but it may be administered any time during an attack. If migraine symptoms return, a 2nd dose may be used. Allow at least 4 hr between doses, and do not use more than 2 tablets in any 24-hr period. Do not use to treat more than 4 headaches per mo.
  • Advise patient that lying down in a darkened room following naratriptan administration may further help relieve headache.
  • Advise patient that overuse (use more than 10 days/mo) may lead to exacerbation of headache (migraine-like daily headaches, or as a marked increase in frequency of migraine attacks). May require gradual withdrawal of naratriptan and treatment of symptoms (transient worsening of headache).
  • Advise patient to notify health care professional prior to next dose of naratriptan if pain or tightness in the chest occurs during use. If pain is severe or does not subside, notify health care professional immediately. If wheezing; heart throbbing; swelling of eyelids, face, or lips; skin rash; skin lumps; or hives occur, notify health care professional immediately and do not take more naratriptan without approval of health care professional. If feelings of tingling, heat, flushing, heaviness, pressure, drowsiness, dizziness, tiredness, or sickness develop, discuss with health care professional at next visit.
  • Instruct patient not to take additional naratriptan if no response is seen with initial dose without consulting health care professional. There is no evidence that 5 mg provides greater relief than 2.5-mg dose. Additional naratriptan doses are not likely to be effective, and alternative medications, as previously discussed with health care professional, may be used.
  • Naratriptan may cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to avoid alcohol, which aggravates headaches, during naratriptan use.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications. Patients concurrently taking SSRI or SNRI antidepressants should notify health care professional promptly if signs of serotonin syndrome (mental status changes: agitation, hallucinations, coma; autonomic instability: tachycardia, labile BP, hyperthermia; neuromuscular aberrations: hyperreflexia, incoordination; and/or gastrointestinal symptoms: nausea, vomiting, diarrhea) occur.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

• Relief of migraine attack.

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